Provider Demographics
NPI:1366480709
Name:SIBLEY, DENISE S (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:S
Last Name:SIBLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 PRINCETON RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2056
Mailing Address - Country:US
Mailing Address - Phone:423-283-0333
Mailing Address - Fax:423-283-0518
Practice Address - Street 1:403 PRINCETON RD
Practice Address - Street 2:SUITE 7
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2056
Practice Address - Country:US
Practice Address - Phone:423-283-0333
Practice Address - Fax:423-283-0518
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD20001207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0101OtherJOHN DEERE
TN4054870OtherBCBS OF TN
TN3883716Medicaid
TN3883716Medicaid
TNTN0101OtherJOHN DEERE